This website is designed for healthcare professionals. Patients with chronic pain seeking treatment advice
should speak to a doctor, and may also wish to access the patient resources that are freely available
on the CHANGE PAIN® website

What can you do to improve analgesia without increasing NSAID dose in patients with chronic pain?

Her physician is trying to help, but Kathy finds it hard to explain exactly how her pain feels.

Kathy finds that pain is particularly bad during physical activity, but she wants to live an active life, especially as she has a rewarding job and a young family.

Kathy’s physician is reluctant to increase the NSAID dose because of the risk of side effects, and suspects that in any case NSAIDs on their own might not be the answer to the type of pain that Kathy is experiencing.

Kathy is one of many sufferers of chronic pain to endure insufficient pain relief1.

Learn what can you do to improve analgesia without increasing NSAID dose in patients with chronic pain

In Europe, a survey found that 40% of patients with chronic pain suffer from insufficient pain relief1, and a greater number (64%) experience insufficient pain relief “at times” — with as many as 79% enduring pain during activity1. Proportions varied in different European countries, perhaps as a result of variation in pain management approaches and pain medicine preferences.

NSAIDs are the most commonly prescribed medication for chronic pain in Europe1, but insufficient pain relief remains high1

Insufficient pain relief remains a problem for many patients receiving NSAIDs1. Some patients with chronic pain report that doctors can sometimes prioritise the treatment of their condition, such as inflammation, over ensuring adequate analgesia1. Adding on a weak opioid to NSAID treatment can be effective in the treatment of pain as demonstrated in OA flare pain and knee OA pain3,4.

70% of European patients receiving NSAIDs for chronic pain need to change treatments because of insufficient pain relief2

Find out about tools that help your patient to describe the nature of their chronic pain in order to decide for the right pain management approach

Tools to help a patient explain pain, pain relief and pain medication side effects can help a physician understand each patient’s individual needs for pain management5. Is Kathy’s pain nociceptive, neuropathic, or both? Would Kathy prefer to accept a higher level of pain while limiting side effects, or would she be willing to endure side effects to obtain improved pain relief?

How to balance analgesia and NSAID side effects in patients with chronic pain

Continuous use of NSAIDs in chronic pain can lead to poor GI tolerability and, in some cases, serious GI, CV or renal side effects6. For this reason, the European Medicines Agency caution that NSAID treatment should be “at the lowest effective dose for the shortest possible duration to control symptoms”7. As the elderly are at higher risk of GI, CV and renal adverse events, the American Geriatric Society recommends that NSAIDs should be “considered rarely, and with extreme caution, in highly selected individuals”8. Although PPIs (proton pump inhibitors) can be co-prescribed to improve GI tolerability, these drugs carry their own risks9,10 and the risks of CV or renal adverse events remain.

Which therapy combination best treats chronic pain? Can a combination therapy with a weak opioid in combination with paracetamol help to improve the efficacy of analgesia?

Targeting different pain pathways may help to manage chronic pain11. The need for involvement of multiple pathways to treat accordingly in patients with chronic pain is now being recognized12. An example of treating multiple pain pathways is the use of a nonclassical opioids together with paracetamol11. Nonclassical opioids are thought to target other pain pathways in addition to the mµ opioid receptor13, and add-in paracetamol is thought to improve the analgesic efficacy of nonclassical opioids12. In patients with chronic pain that is associated with inflammation, the anti-inflammatory activity of NSAIDs can be combined with a nonclassical opioid (+ paracetamol) for pain relief that targets multiple pathways3,4. Improved analgesia with a combined treatment may also enable side effects to be reduced by using lower doses of individual agents compared with monotherapy as demonstrated for treatment of hip OA related pain11.

7. European Medicines Agency, Evaluation of Medicines for Human Use. Opinion of the committee for medicinal products for human use pursuant to article 5(3) of regulation (EC) No 726/2004, For nonselective non–steroidal anti–inflammatory drugs (NSAIDs). EMEA/CHMP/410051/2006; EMEA/H/A–5.3/800